Woman's Hour - UTI treatment, Being dumped by text, Lighthouse keeper

Episode Date: December 27, 2023

Up to half of women will have a UTI at some point in their life. Earlier this year the NHS launched a new awareness campaign which the filmaker and author Kate Muir has criticised for not mentioning vaginal oestrogen as a treatment. Kate joins Krupa Padhy alongside Dr Olivia Hum, a GP who is on the Council of the British Menopause Society. Dr Ronny Cheung speaks to Krupa about the double-edge sword of children building their immunities in their early years and the disruption caused to working parents and carers. What do parents need to know about caring for a child with seasonal colds and coughs? Sally Snowman is the last official lighthouse keeper in the United States and at the end of this month she will retire after two decades of service. She's the first and last woman to be the lighthouse keeper for Boston Light in Massachusetts. She joins Krupa to discuss what it's like being a lighthouse keeper and how she feels about leaving it.We know that Christmas and New Year, although filled with joy for some, can put a really big strain on relationships and it can be a time when people in an unhappy relationship decide to end them. But is there ever a good way to break up a relationship? And is it ever acceptable or kinder to end something by text? Krupa is joined by Olivia Petter, journalist and author of Millennial Love and Vicky Spratt, journalist and documentary maker.The award winning comedian, writer, playwright and actor Meera Syal – known for her comedy series such as Goodness Gracious Me and The Kumars - has been talking to Ros Akins on Radio 4’s Media Show, we can hear some of that interview.Presenter: Krupa Padhy Producer: Emma Pearce

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BBC Sounds. Music, radio, podcasts. Hello, this is Krupal Bharti and you're listening to the Woman's Hour podcast. Good morning, thank you for being with us. The new year is creeping up on us and there's long been a debate about whether January has become the most popular month for relationships to end. Some even call it breakup season. And we're talking about this because of an article we spotted by Kate Kibb in Cosmopolitan magazine. In it, she writes that when it comes to breaking up, there is no good way to do it, just bad ways and worse ones. But here is what really got us talking. Kate says that doing it over text is, in her opinion, one of the lesser evils when it

comes to letting a former partner know that they are now single. Not only does a text message breakup give the heartbroken party the privacy to feel whatever messy feelings they need to feel about it, it also buys them the time and space to process those feelings and express them the way that they want to. What do you think? Have you ever been dumped by text or WhatsApp message? Or have you ever ended a relationship this way? How we meet our partners is changing. So is it only natural that the way we are breaking up with them is changing too?

Some of you have already been in touch. This listener says, I flew to him in Shanghai to get dumped. I really wish he had done it by text. You can text the programme. That number is 84844 over on social media. We are on the handle at BBC Women's Hour. And you can, of course, email us via our website or you can send us a WhatsApp message or voice note

using the number 03700100444. All of our terms and conditions can be found over on our website. I'm also looking forward to introducing you to Sally Snowman, the last official lighthouse keeper in the United States. The Boston Light has been her home for two decades. She's the first and last female to take on that role. She says she lives, breathes, eats it and now she's stepping down. And from one epic woman to another, we'll hear from the award-winning writer, playwright and actor Mira Seil. Also, up to 50% of women will have one at some point in their life. So is it time to rethink our treatment of urinary tract infections or UTIs?

All of that coming up and we're starting on health too, because it is the time of the year when so many of us are struck down by seasonal colds and coughs. Other parents and carers of children, there's the added dilemma of when it's okay to send your child back to school or nursery or childcare. Added to that is the stress and anxiety for working parents of knowing that you might be called to pick up a sick child and here's an example from one of our listeners Laura who got in touch to say I'm a full-time working mum with with a two and three-year-old and most weeks one of them is off a day with a seasonal virus I'm sure that is something that many of our listeners can relate to so what do parents need to know to help them navigate this time when children are building up

their immunities and getting sick with those various viruses? And is there a vaccine on the horizon? With me is Dr. Ronnie Chung, a consultant paediatrician and officer for health services at the Royal College of Paediatrics and Child Health. Thanks for being with us, Dr. Chung. Thanks for having me, Cooper. It's really tough as a parent to see your child under the weather with those coughs and colds and various viruses. But how important is it that they get these various illnesses for their immunity? Yeah, I mean, it's actually incredibly important.

I mean, firstly, it's apart from being a sort of children's doctor, I'm also a parent myself. So I can totally empathise with how parents will feel when they see a child that, you know, they're worried about them being ill, or even if they're not worried, you know, it's sort of heartbreaking, isn't it, to see your child be unwell and be unwell, you know, frequently. But it is really important to say two things. One is it's really important that they have these viruses, because it's the way that they, we as human beings, you know, generate immunity and protect ourselves in later life. But also, it's completely natural, and it's a completely normal part of early childhood. So even if it's difficult to witness, it's really important that we recognise that this is just what part of what growing up means.

When you are caring for a little one and it does feel like they are perpetually sick sometimes, that, you know, one gets better, another gets poorly. Put this into context for us. How many seasonal viruses do children get per year, especially in those early years? And how long does this phase last? Yeah, it's a really good story. It's one of the commonest questions I get asked when I see patients and parents in clinic, actually, because obviously it's a very worrying thing. And that story that Laura's kind of, that you've read out from Laura is something that I hear a lot about. So there's actually quite good evidence to say we've looked at this over populations over a period of time. And on average, a preschool child, so someone up to the age of five, would get somewhere between eight and ten upper respiratory infections a year.

Now, if you think about what that means, that's on average. Some children will get fewer, but some will get more and still be completely you know part of the normal spectrum of illness that's maybe once one a month on average something like that each time maybe lasting about a week or so and sometimes even things like a little cough and things might last even longer than that so it can really feel like it's never ending it's completely perpetual but it's you know if you think about that that's the sort of range of normality. Actually, when we see that and we see that you've got two children, you've got three children, they overlap each other, it's often completely normal. There is, of course, the potential huge disruption to working parents or carers, approximately 50 days a year caring for a sick child in their early years. I mean, I

personally have lost count of the number of parents and carers, specifically women who have felt guilty for not coming into the office. And this, of course, includes me. When you are not able to work to look after an unwell child, do you think there's enough awareness of this amongst parents and employers uh so no i mean i think i think there isn't probably enough um partly because what i've just said before you know one of that question about how frequently um you know children get infections is something i get asked all the time and connect so therefore i you know by definition i think it means we don't mention it enough and you know i myself again as a sort of working parent over the years have missed lots of days off and and and my my wife also we've kind of had to balance that

and and i think it's really important that we kind of as a society recognize that this is an important part of caring and particularly caring for young children um and uh and i think there are things that we could do to make that better to get that message out to people to understand that actually this is a part of normal normal childhood and therefore you know it's completely you know something that we can anticipate and something as a society we should we should prepare for essentially. Yeah I mean I often find that many employers have various policies in place but people don't actually know that they exist and that's often a challenge. Let's move on to the kind of medical side of all of this. Practically speaking, when your child has that seasonal cough or cold, what do they need to get better?

So I find that I have quite a lot of faith in parents and parents, generally speaking, recognise when their child is is unwell and recognise what they they need to do. And I think I wouldn't tend to over medicalize this this is something as i say that actually happens all the time and is a perfectly natural part of uh of kind of childhood and parenting and so most of the most of the time it's really simple sensible common sense stuff you know making sure that they're well hydrated making sure that they rest and they need to rest um A couple of things that come up sometimes, specific questions. One is about, you know, whether or not they should be eating and eating enough for night. And people, parents often worry about that. And, you know, you and I know how it

feels to be unwell ourselves. And sometimes when we're unwell, we just don't fancy eating. And that's okay, as long as they make sure that they have, you know, just about enough to keep things going and that they're well hydrated. The other kind of common question that people ask me about is what about when they have a temperature? What should I do with that? If they have a high temperature, people can really worry people. But actually, from a medical perspective, the temperature is completely normal too. It's part of the body's response to generating that kind of immunity, generating the response to the virus itself.

So we don't have to treat that necessarily just because of the temperature's up. But if the temperature is making the child feel unwell, then absolutely simple things like paracetamol, norepinephrine, those kinds of things are kind of important, but only, as I say, to make them feel better. I know you say that fevers shouldn't be a particular worry, but naturally I think parents, carers do worry about their child getting a fever, especially if it's not coming down. And you've touched on it there, but at what point should you start worrying about a fever?

Yeah, so I think, as I say, the main thing about the fever is to recognise that it is a part of the normal reaction. And if the child is feeling unwell with it, so they're feeling grotty, you know, sick, you can see what they look like, don't they, can't you, when the temperature goes up? Then I think that's the time to treat that. It's very uncommon that actually having a very high temperature

causes any particular problem. Now, by and large, with most infections, it is not the height of the temperature that I worry about. It's actually how the child is feeling and acting. So if you're worried about how they are in general, how sick they look in general, then absolutely trust your instinct and ask for medical advice if need be. But I wouldn't rely just on the temperature on its own, if that makes sense. We've spoken about the guilt that parents feel not being able to go into work. So conversely, when can you send your child back to childcare?

From a doctor's perspective, what are those boundaries? So I think there's two questions to answer about that. One is really about the individual child. So in other words, when do they feel well enough? And what do you think as a parent that they're well enough to go back? And again, I think most parents have a sort of pretty good sense about when their child is sort of ready to take on the rigours of being back at school or being in childcare in general. And certainly that's when they're starting to recover. Now, the other side of that is thinking about protecting, I guess, the health of all the

other children that are in the health, in the childcare setting, whether that's a nursery or school. And indeed the staff as well. And staff, absolutely. Absolutely right. And childminders and everybody else. So I think it's really important to think, to understand that actually, although it's frustrating. And again, as a parent myself, it's been frustrating for me to have to sit at home with a child that I think is well enough. There's a reason why the nurseries have and childcare settings have kind of rules around what that is. And it is as much to protect the children and the staff as anybody else. But my experience is that actually most nurseries have a pretty good evidence based kind of way of thinking about how to protect their staff.

And the rules are there for a reason. So, but if you are worried about it, you know, by all means, bring it up with them and sort of talk it through because, you know, I'm sure that in my experience, again, they're quite open to talking about some of these kind of rules and regulations, etc. I mean, I'd say part of the problem there is the sheer cost of childcare and nurseries and not wanting to miss out financially as well. But that's another conversation. I want to move on to something very specific here we know that 80% of hospital admissions for a seasonal respiratory virus in children and older adults are caused by RSV first of all just explain what RSV is and what the symptoms are of that virus

yeah so RSV is a very common it's in fact one of the commonest um causes of respiratory infections in both young very young children but also in the elderly um that are around and every year it causes hospitalizations it's probably the commonest cause of hospitalizations in fact for infants across the developed uh world um and it's something that we, you know, as pediatricians and doctors and see every year affecting lots and lots of children and lots and lots of elderly people make giving them, I should say, kind of sometimes some quite severe respiratory infections and even some deaths. And I do believe that there is some good news about a vaccine for RSV. Yeah, absolutely. So this has been something that we,

you know, as paediatricians, we've been kind of seeing on the horizon for decades. And finally, we have some real hope. There is an RSV vaccine that's been licensed. And in fact, the Joint Committee for Vaccinations and Immunisations,

the JCVI, has recommended that it should be rolled out nationally. And unfortunately, we missed it for this winter. But hopefully, from next winter, we'll be able to provide protection against this very common and dreadful virus, which actually would, as I say, if you think about the numbers, the fact that they account for 80% of hospital admissions with respiratory infections in that age group. It's an enormous number of children that will be saved from that particular kind of outcome. But also just think about the impact on the kind of NHS, the burden of disease in the NHS, which is so stretched at the moment, how much we can kind of relieve the system of that pressure so i think it's a real really good good news and we hope that the government will be able to get that

uh our virus vaccine out and ready for for next winter and dr jung just before i let you go in the same vein uh last month the joint committee on vaccination and immunization advised the nhs to give all children a vaccination against chickenpox something that has only been available privately up until now is there something to be said therefore about vaccinating children against illnesses like chickenpox which many of us adults will have had yeah so i think so the first thing to say is i think that actually the the childhood immunization program is something that we that i 100 support and this is a really important part of keeping our children and young people and adults actually safe uh in the future so so and adding the the chickenpox vaccine is a is a another step to that uh kind of uh that kind of overall process of

protection um so chickenpox i think is one of those illnesses that i think sometimes people can feel is a little bit of a common thing. We all get it and we all get better by and large from it. But actually, again, in small numbers, it can cause really severe infection. And as much as possible, we put these things in to protect exactly against the things that you talked about right at the beginning, but actually the impact on the families and on working parents and everything else of all these illnesses is really great if you add it cumulatively up. So even if you're thinking about the health costs, but the sort of societal costs. And so I think this is a really important step towards, again, tackling some of those issues that we talked about and helping, you know,

working families get on and be as productive as they possibly can. Working families like Ruth in Whitney who said, with more grandparents helping out with childcare these days, you will find that there are therefore more illnesses in the older age group. I and two of my neighbours help look after our grandchildren and we have all been on well over Christmas. It takes longer for older people to bounce back. And this one who says, I am a headteacher in London.

I think we unfairly punish illness by setting unrealistic targets for attendance. Children rewarded for high attendance. Listening to your piece has made me realise we are punishing healthy immune systems. Such a fascinating conversation and great to have your expertise, Dr. Ronnie Chung there. Next, we're going to talk about a career that I imagine many of you will not know a lot about. Let me introduce you to Sally Snowman, the last official lighthouse keeper in the United States. At the end of this month, at the age of 72, she will retire.

The lighthouse has been her life for two decades now. She's the first and last woman to be the lighthouse keeper for Boston Light, set up in 1716 on Little Brewster Island in the outer Boston Harbour in Massachusetts and she took on the role in 2003. I'm delighted to say that Sally joins us now. Good morning or good evening Sally. I'm not quite sure the time zone there. Yes good morning. Good morning and thank you for waking up to speak to us. You look wonderful by the way. I'm going to get you to describe your outfit a little later but first of of all, let's start with the kind of

roots of this story. Where did your love of lighthouses come from? From childhood. I live near the water, just south of Boston in Massachusetts. And so as a child, my dad would take us out, you know, cruising the harbor and whatever. And one of my favorite places was going out and having views of Boston Light. I'm so fortunate to have this literally in my backyard. And it's just so amazing that when I was a child, my dad had made arrangements so that we could go and visit the island. Didn't climb the tower, but to just go on the island and walk around and what have you. And he anchored the boat. We got in the dinghy, rode to the island, stepped off onto the beach and looked up at the boat we got in the dinghy rode to the island stepped off onto the beach looked up at the lighthouse tower and said daddy when I grow up I want to get married out there

and that has and then just reading stories about lighthouses and so lighthouses have been a passion all my life you paint a beautiful picture, Sally. And you said there that you said to your dad, Daddy, I want to get married here. And that's exactly what you did. Yes. Yes, we did. And little did I know at that time

that I would be a keeper someday. And that was another childhood thing, just dreaming of, gee, I'd like to be a lighthouse keeper and so on and so forth. And how did that come about? How did you become a lighthouse keeper? Divine province? Divine Province, it's just, and the story from how I went out there when I was a 10, and in the U.S., we have the Coast Guard, and the Coast Guard has four components to it. The active duty, reserves, civilian, and the volunteers.

So when I was 24, I joined the Coast Guard Auxiliary. My dad, he was in the Auxiliary too, and that's how we got permission to go out there and have that one visit when I was 10. And so as a Coast Guard Auxiliarist and had the opportunity to get married out there, I met my husband in the Coast Guard Auxiliary. And then the Boston Harbor Islands National and State Park was established in 1996. And one of the players, one of the 34 islands and peninsulas in Boston Harbor for that park was Little Booster Island. And so after Jay and I got married out there, we started volunteering out there and doing watches, spending three, four, sometimes a week out there with the active duty. And then once the park opened up and they were bringing visitors out there, they wanted to have the Coast Guard Auxiliary help augment the National Park Service. And they were looking for someone that knew about

Boston Light history well it just so happened that after my husband and I went out to Boston Light and were out there for a few years we delved into the history of Boston Light we did five years of research and published a book. So when the Park Service wanted to start giving tours, the Coast Guard said, hey, if you want to know anything about Boston Light, contact Sally. And then what we had in 2001 was the terrorist attack on the Twin Towers in New York City. Yes. And the Coast Guard needs to take the active duty personnel off the island. And so there was no one out there.

The lights automated. So you really don't have to have anybody out there. The lights are automated. So you really don't have to have anybody out there. But when the Park Service wanted to start doing tours again, they came to me, Sally, and said, hey, you've been out there, you've trained a cadre of auxiliarists and historical interpreters. And as watchstanders, can you open the island up and resume the tours and so I did that and the Coast Guard realized after that they needed those three active duty personnel on the island for what was now the Department of Homeland Security to protect our shores. And is that the bulk of your job then the kind of tours and looking after the island? That's one of them. I'm also the facilities manager. I'm the point of contact for inquiries.

I get the impression you're a one-woman band, managing the island, managing the lighthouse. Yes. It's been a passion. I have lived just Boston-like for 20 years. Yeah, yeah. I mentioned your wonderful outfit, costume. Describe it to our listeners. And why are you wearing it? Well, the island is very small. It's three and a half acres at low tide, two acres at high tide. And when I got hired to be a civilian, I couldn't wear my auxiliary volunteer uniform anymore. And so when the coast guard hired me, they said, Sally, we want you to stand up from the crowd. What are you going to wear? I said,

well, just you wait and see. And we have a whole history of Boston Light. We know that the British built the tower in 1716 as the colony of Massachusetts was being developed. And then the revolution came in 1776, and the British said, hey, if we can't have this tower, we're going to definitely not let the colonists have it, and they blew it up on the way out of Dodge. So the's a bonnet, a full dress, and a scarf, an apron. And so that was what the women would have worn during that era. Yeah, you've really embraced it. You've really embraced the characters, the history, all of it. I must ask you about being a woman doing this job, because there aren't many women doing this job.

It's not a job that is associated with women. What's that experience been like for you? Has it been different? Well, there have been women keepers throughout um you know the past centuries but as for boston light um it has had 70 keepers and the first 69 were all men so i'm the first woman for boston light which is you know just such an honor and um and i forgot where we're at so could you ask the question again please i'm just saying it's not really a job that's been associated with women. And you just highlighted that you are the first and the last.

Yes. So the other women just now, like in the past 15 years, women have researched women lighthouse keepers in the United States. So that's another notoriety for me, that there's one last lighthouse keeper in the United States, and it's a woman. Yeah, and you clearly embrace that role. This is the end of the road for you in terms of this specific job. What are you going to miss? Well, I was able to live out on the island seasonally up until 2018.

And we had real bad storms that winter. And there was damage done, what have you. So I have been missing being able to live out there for the past four years. And the most favorite part is watching the sunrises and the sunset. It sits right on the cusp of Boston Harbor and the Atlantic Ocean. So the views, it's unobstructed. So looking at the Atlantic Ocean on one side and the city of Boston 10 miles away. Yeah, beautiful sight.

The far expanse of the universe. Thank you so much, Sally Snowman. Whatever the next chapter means for you, we wish you all the very best and an absolute pleasure to hear from the last official lighthouse keeper in the United States there. Now, this time of the year for many involves spending a lot of quality time with loved ones. We also know that it can put big strains on relationships and it can be a time when people in an unhappy relationship decides to end that relationship. But is there ever a good way to do so? Is there ever a good way to break up?

And is it ever acceptable or kinder even to end something by text rather than a meeting face to face? Well, with me to talk about all of this are Olivia Petter, journalist and author of Millennial Love, and Vicky Spratt, journalist and documentary maker. Good morning to you both. Good morning. Good morning. Vicky, let me start with you. A few years ago, you received a text message and it began with the words, we need to talk. And it's really ended up having a lasting impact on your life. Yeah, I did. The relationship I have with my long-term partner of nearly 10 years actually ended over text, which I think was such a defining moment in my adult life that I'll probably never forget it. And I think I've come away from that incident thinking you should never have a particularly important conversation over text message.

I think they are, for the phone at minimum, and in person, ideally. I say that it's had a lasting impact on your life, because it's been quite triggering since, hasn't it? Well, I don't want to, I don't want to overplay it. But yeah, now, if anybody texts me in an ambiguous way, I always assume the worst. And I had to say to a lot of my very close friends after this happened, if you've got something to say, please just call me. And otherwise, just make it really, really clear what it is that you're texting me about. I mean, it's got better now, four years later, but in the immediate aftermath, I almost couldn't look at my phone. And what I have started doing is using emojis now when I'm communicating with people, because I want to make myself really clear. And I think when you're communicating via WhatsApp, text message or any other form of written communication,

you know, the usual signals that you would read on another person's face or with their body language are missing. So I think you have to try and inject tone in any way that you can. Because often we think about emojis as being a bit of a pain or a bit of a nuisance and unneeded. But yeah, that's an interesting point about it expressing a bit more depth and emotion. Olivia, the relationship landscape, it's changing, isn't it? Especially in the early days of a relationship. I know you've spoken a lot about the rise in situationships. I like that term.

What are we seeing in terms of how relationships are beginning and unfolding? So I'd say the modern dating landscape is completely defined by ambiguity. And that's exactly what this kind of rise of situationships is as a trend. You know, the definition of that is essentially that there is no definition. It's sort of this idea of people very casually dating and seeing each other and the difficulty of that is that there's no clear beginning and there's no clear ending so it creates a lot of anxiety and a lot of stress in the modern dating experience but this is how a lot of people are starting to see each other now and even that in itself you know you say seeing each other rather than dating it's all it comes from this kind of fear of being vulnerable being reared in a nation that is famously emotionally inarticulate and all

of that kind of combines to create a very anxiety inducing dating experience yeah vicky would you agree there's a lot of guesswork isn't't there, in modern day relationships? Oh, absolutely. But I'm not sure there's any more than there's ever been. People have always had to wonder about what their potential partner or partner was thinking. I mean, Jane Austen wrote thousands and thousands of words about it. So I don't know that there's necessarily more ambiguity. And I do wonder how much you can ever really know what another person's thinking. But I think it's definitely exacerbated by the way that we have so much quick, throwaway communication. Let's hear from a few of our listeners

who have been messaging about this. Julia says, I met my first boyfriend when we were both teenagers. I soon realized I had nothing in common with him and wanted to escape, but didn't know how. I scoured the problem pages for advice on offloading an unwanted boyfriend in vain. The relationship dragged on for years until I finally told him I wish someone had advised me to end it when I first wanted to. Honesty is the best.

Julia going for the old fashioned approach there. And Ron says over 35 years I saved up for my first solo trip abroad I was going to Montreal to spend a couple of weeks traveling around Canada with my then girlfriend of over five years my girlfriend told me she was thinking that we should break up after several hours of talking crying and hugging we decided to carry on with the holiday and see how it went we've now been married for 34 years that's from Ron I'm glad you guys have stayed together. But face to face doesn't always end in a happy ending, does it, Olivia? No, I mean, definitely not. I think the thing is, look, there's no good way to end a relationship with someone. It's always going to be a difficult piece of news to receive. I do think it is slightly sociopathic to end a long term relationship out

of the blue over text. but I think there are a lot of benefits to doing it that way you know if you think about it think about how you want to receive bad news you kind of want to get it over and done with quickly and you kind of want to be within the privacy of your own space to receive it and process it if you do that in person it's going to be a lot more difficult and you might react in in a way that doesn't necessarily reflect exactly how you feel and then will create further problems down the line. And then you go through that phase of procrastinating and thinking about what you've said and you wish you'd said that or said it in a different way. Vicky, I wonder whether you think there are ever any circumstances when ending a relationship via text is acceptable? I think it probably is in direct proportion to how long you've known the

person and what kind of relationship you've had with them. I do think if you've only been on one or two dates, it's okay to text someone. I think as was in my situation, if you share a mortgage with someone, it's probably not okay. So I think there's a sort of space-time continuum that needs to be considered when you're deciding how to communicate that sort of thing. there's a sort of space-time continuum that needs to be considered when you're deciding how to communicate that sort of thing. Here's a good point from Linda on Twitter. She says, better than being ghosted altogether when the person just ignores or never replies to you.

I think I tend to agree. What do you think, Olivia? Yeah, I mean, ghosting is, again, a byproduct of this terrible lack of communication that we have within the dating landscape now. I think it seems like the easier option as opposed to actually having to be forthright with someone about how you're feeling. I think people fear that so much that they think the easier option is just to never reply to anyone and ignore them again. But, you know, anyone who has been ghosted will know how psychologically damaging that can feel. And it's so much easier for the other person and kinder to have that total clarity as to the relationship being over and the other person no longer being interested in seeing you again. And I think that can sometimes be

much more articulately expressed over message than in person. But that said, there are ways to go about it. And it is totally dependent on the context of the relationship that you've had, as Vicky said. And you make a good point Olivia that the way a relationship ends can really have a lasting impact about what the individual being dumped or having the relationship ended feels about themselves. Vicky would you agree? Absolutely I agree. I think that when you've been intimate with someone you've given so much of yourself to them and I think we all owe each been intimate with someone, you've given so much of yourself to them. And I think we all owe each other a bit more care than there is currently being given to

one another. And you just don't know how somebody will receive your words. And I think we should all endeavour to think a little bit more about that. Joanna writes, my ex and I were trying for a child after being together a decade. I was 40 then. he then decided to dump me via text saying he doesn't want to have children anymore and that's it. No explanation, no closure. It's impacted me massively because it was out of the blue. Method of communication was hurtful, but the lack of reason is more hurtful. It's made me insecure and wary of getting into another relationship.

He didn't have to waste my time and now it's too late for me to have children. And that just underlines what we were talking about, how the way a relationship ends can have a lasting impact on the individual. And this one from Carol says, I have a friend who found out she'd been dumped when her former partner changed his status on Facebook

from in a relationship to single. That's a good point from Carol. There are so many ways to end a relationship now with social media platforms it's almost hard to keep track of your own relationship isn't it olivia yeah i mean i was dumped by voicemail when i was 12 so that was particularly innovative um at the time i can see the appeal from his point of view because i mean i was 12 to clarify yeah but you know he thought it's you know she can hear my voice I can get out everything that I want to say and then I can hang up the phone and it's done

and I never have to speak to her again so I understand the efficiency point of view but um from on the receiving end it's it's not the best not the best way to receive and Vicky I want to end with you the best words to use if you want to bring an end to a relationship in your in your opinion well now having been through what i've been through i think you just have to speak from the heart and be honest and make it about you not about the other person you are leaving a relationship that's your choice there might be things that you absolutely loathe about them but don't say things they're going to hold on to for the rest of their life just be really really clear about what it is that you need and what you're doing.

Be as kind as you can. And if you're really sure that it's over, don't leave any wriggle room, because I think that can also be really cruel. But I think it's just about giving people clarity. That's good advice. Thank you so much, Vicky Spratt and Olivia Petter, on that conversation about breaking up by text. Do keep your messages coming in on this subject to social media. We are at BBC Women's Hour. And a quick reminder, you can catch up with any of our shows online,

including our special Boxing Day programme yesterday, where Nuala spoke to a selection of fascinating women who dig for the truth. I think my special skill set is just always just taking things, going one step too far. So it's just who I am, really. So it kind of came naturally to work with Detective Lauren and use some of our unique tricks to crack the case. I mean, I've chased people around hedges. I've driven after people singing Dolly Parton at the top of my voice, not realising my dashcam had sound. I believe that truth matters.

And I think it matters whether that's today, tomorrow or 500 years ago. In 2018, and I asked the students to play some music written by women and they could not really find any. And you can listen back to that programme. I thoroughly recommend that you do by searching for Women's Hour over on BBC Sounds Next, the award-winning comedian, writer, playwright and actor Meera Sial has this month been awarded a Lifetime Achievement Award

at the Women in Film and Television Awards The award celebrates the success and achievements of women in front of and behind the camera Earlier this year she was presented with a BAFTA fellowship, the Academy's highest honour. And she's been talking to Ros Atkins on Radio 4's media show. The first time I realised that being an actor was an actual option was when I was taken to a pantomime.

And this is why pantomimes are so important for kids because it's often their first experience of theatre and live performance. With the Sunday school in the village, and it was Dick Whittington at Stoke, and there was a bit where they chose a child from the audience to come down and pat the villain on the head to show that he was going to be a good boy, and I got chosen. And it is actually one of those classic moments.

It would be a great scene in a film, actually. So I walk down the dark stairs into the circle of light and I feel the light on my face and the actors are this close and I can see their make-up running and I can see their laboured breath and I pat the villain and I smell those smells and I go, what is this place? I don't know what it is, but it's home. This is where anything is possible.

So that was the moment I realised what an actor was and that's when I fell in love with it, I think. So that happened as a girl growing up in a mining village and doing a school trip to Stoke. I also wanted to ask you about Bargy on the Beach because this is a quite significant thing for you to take on, a screenplay for a feature film all about a group of Asian

women from Birmingham on an outing to Blackpool. There are lots of things I would like to ask about this. So before we get to that, let's hear some of it. Hello, sisters. Namaste, Sat Sri Akal, Assalamu Alaikum. As coordinator of the Saheli Women's Centre, I'd like to welcome you all to our first Blackpool Illuminations outing. It is not often that we women get away from the patriarchal demands made on us in our daily lives, struggling between the double yoke of racism and sexism that we bear. This is your day. Have a female fun time so you wrote that in 1993 what made you take that on what an undertaking to not not just write a screenplay but be involved

in producing it as well it was this absolute desire and it's never left me to tell the stories that aren't being told because there was such a stark contrast between the kinds of parts i was being offered as a performer and what i saw in my real life, a huge schism. I know I've joked about it a lot, but it really was victim of arranged marriage, woman in corner shop, you know, caring but committed social worker with two lines. Very limited and not at all reflective of the extraordinary dynamic matriarchs that I grew up surrounded by. And I just couldn't understand why these stories weren't being told. Do you think between 1993 and now it's got easier for those stories

to find platforms, to get commissions, to get funding from the media? At the moment it's probably harder, I think. Really? I think in some ways. I don't know how easy it will be to get Bajie on the beach off the ground now. The independent film market is really being squeezed. I think if we were trying to sell it, they would go, well, who are the stars that can sell it? Well, I can't think of many still that we have that could sell a movie. I mean, it's become a very different kind of marketplace. This was a

commission from Film on 4 and their remit was absolutely to give those voices that haven't been heard a chance to be heard. And it was the quickest commission I've ever got in my life. I went in, chatted to Karen Bamber for five minutes and came out with a commission. Just looking as you're talking, some new research from the Creative Diversity Network, which found the number of female writers and directors of British TV shows fell between 2016 and 2022. And the gender gap for female directors and writers has increased over the past six years. Kind of not surprising from people in the industry

that are slightly feeling that pinch. I think, you know, now everyone's trying to compete with the streamers, the things that you, you know, we're back to the algorithm and I'm not the only one. We've been told this is fantastic writing, this is a fantastic script, but it doesn't really fit our remit at the moment. Is remit another word for algorithm? I don't know. I understand why people are being cautious and there's all kinds of budgetary squeezes on. You don't always know the exact reasons,

you just know the effects and the effect at the moment for a lot of creatives is that this isn't the time to push anything that's too outside the box, which a sad thing to say but everything is cyclical isn't it so you're describing a challenge really in terms of what gets commissioned but you've also repeatedly turned to the issue of diversity within the industry for example recently you said diversity in tv is not just in front of the camera but in the writer's room and makeup vans and around tables where deals are done you evidently don't think that part of the industry has shifted anywhere near enough either camera but in the writer's room and makeup vans and around tables where deals are done you evidently don't think that part of the industry has shifted anywhere near enough either i would say there's a huge improvement i would and i've noticed that on sets and that is really heartening

of course we have a way to go because it's all proportionate isn't it but i and there are certain companies that are that are much better than others um at doing it and you do notice it when you walk on a set so i would say there's a new awareness and i think that people it's not a good look anymore frankly and that's a great thing even if people don't think it in their hearts they know it's not it's not a good look and i don't care if that's the reason that people change as long as it does change so i would say there is movement there. And, you know, that's the thing. I mean, when you get an award, it makes you look back. It makes you reflect. And if I reflect on what the industry was like when I entered it,

there have been, you know, it's so much progress. Who would have believed it on the day that Indu Rubasingam has been, you know, made the director of the National Theatre, which is amazing news. So I always try and that's why I said it's cyclical. I always try and keep that in mind because I'm an optimist. And I think anybody that's in this industry is actually however depressed they get is fundamentally an optimist because you have to be one to be a self-employed creative. Of course, you have to hope there is something always around the corner. And that's why we do it.

So whatever I say and all of the things I sort of fight for and advocate for, it is in the spirit of hope that I think we can change things together. We just need to remind each other, occasionally look back and remind ourselves how far we've come, but never get complacent. That was Meera Sial in conversation with Roz Atkins. And you can hear the full interview later today at 4.30 on Radio 4. And if you are a real fan of Meera Sial, you can hear her alongside French and Saunders on Radio 4 this evening at 6.30 in the comedy Whatever Happened to Baby Jane Austen. Previous episodes of the series are over on BBC Sounds right now.

UTIs or urinary tract infections are something many women have experienced. They can range from the uncomfortable to the downright unbearable. Up to half of women will have one at some point in their life, with between 20 to 30% of us having a recurring UTI. And whilst both sexes can get them, they are most common in women over 65. Recent data shows that they led to more than 800,000 admissions to hospitals across the country over the past five years. Earlier this year, the NHS launched a new awareness campaign to help reduce this number. And my next guest wants to highlight

what she perceives as the lack of awareness and knowledge in this area when it comes to the treatment for women experiencing UTIs, especially later in life. This is the filmmaker and author Kate Muir, who first raised this concern in a recent article for The Observer. Kate has previously worked with Davina McCall on her documentaries on the menopause for Channel 4. And we're also joined by Dr. Olivia Hum, a GP who is on the Council of the British Menopause Society. Welcome to you both. Thank you. Kate, I'm going to start with you. What first got you looking into the subject of UTIs? Well, we first did it on the Davina Channel 4 menopause programme, when Davina herself said, at 44, I was going through

this, I had vaginal atrophy, I didn't know what was going on. And of course, we don't really understand that that is happening to almost the majority of women eventually, that the hormones disappear in the vulva area, and it can cause all these other things and she was really courageous about talking about it and I kept looking at into that issue again and again and then this NHS press release came out in the autumn and it said we must stop these UTIs it had three big experts including a gerontologist on the press release and women must clean themselves better and drink more water and we must be on the lookout for this. And I thought, wait a minute, what is missing here? Vaginal oestrogen, which in huge studies for the last 30 years has shown to reduce the numbers of

eight UTIs in older women. And there was a fantastic study of women in their 70s, which showed using vaginal oestrogen, half the number of UTIs. And in fact, Olivia. Kate just highlighted there some of the language around UTIs, possibly some of the myths as well. Can you strip this right back? Let's go right back to basics. What is a UTI? How does it manifest? So a UTI is a urinary tract infection and the sort of classic symptoms of a UTI are what we call dysuria, which is pain when you pee, frequency, which is peeing more often than usual, and urgency, which is the feeling of desperately needing to go to the loo right now. And we can get other symptoms too, some tummy pain, some people get back pain. But also, I think Kate highlighted in the article, in elderly women, sometimes we don't get any of these symptoms. So we just see someone who will become more confused and they might end up with delirium, which is what you were talking about in the article.

And there are lots of other symptoms that we see. Some would just be off their food. And it's a really big problem in older women. Kate has highlighted her call based on her evidence that she's done research on for vaginal oestrogen as a good treatment for UTIs. How do you understand it as a treatment and what is the current status of it within the NHS? So I think what we need to realise is that the lack of oestrogen to the vulva and vagina after menopause, it's not just about the vulva and vagina, it's also about the urinary symptoms. So we've sort of tried to rename the idea of vulvovaginal atrophy,

which is a horrible word anyway, to genitourinary syndrome of menopause. And that's to highlight the symptoms that many women will get, which are things like all the ones we were talking about, frequency, pain when you pee, all of these things, incontinence can happen to women post-menopausally. And because this is something that doesn't get better with time, it will often get worse and worse. So the first time it affects it will often get worse and worse. So the first time it affects women will often be in their 60s and 70s when they're long past menopause. And they don't think this has anything to do with menopause at all. And for some reason, vaginal oestrogen, which is cheap and easy and safe, has been really, really underused.

So what Kate was talking about in the article is about using it to prevent recurrent UTIs. So these are women who get a lot of UTIs, more than sort of three or four a year. And we know, and it's in the NICE guidelines for recurrent UTIs, that actually using vaginal oestrogen can significantly reduce the number of recurrent UTIs that women get, which is really important, but yet it's just not being used. And we're using antibiotics again and again and again. And one in four women have an antibiotic resistant version of the UTI. And that's really important because that can affect everything else that's happening in your body.

And the other thing I didn't understand till I started looking into this, I was writing a book about the pill, which is coming out next year. And I realised, Olivia, that when some women who are on the pill, who are on the progesterone only pill, also get vaginal dryness. Yeah, absolutely. So there's some groups of women who don't even come into this conversation often. So some women on the progesterone only pill, women who are breastfeeding, interestingly, often get vulvovaginal symptoms. And then the other group is women with breast cancer who are on breast cancer treatments and they get particularly severe vulvovaginal treatments and for years we used to think that vaginal oestrogen was not safe in these

women but actually we know now for many women with breast cancer that vaginal oestrogen is not only really safe but it's also really effective so this is just a conversation which really needs to be had it's something that I talk, I teach a lot of GPs and the British Menopause Society, we run a lot of courses, and we're really trying to put the message out there that vaginal oestrogen is really under-prescribed in the UK, actually all over the world, actually, as you found it in the US as well. So it's something that is really something we need to do more of. But Olivia was just saying to me, she was taught an hour of menopause

in her medical training. And so there's a whole generation of doctors out there that want to deal with this, but have no idea that there is a vaginal microbiome and that you have to keep that biome happy and putting hormones back in a tiny amount creates that sort of fantastic atmosphere. Because we talk about the biome in our gut don't we? Yeah. And we don't understand that they exist in other parts of the

body as well. Yeah absolutely so the vagina is a sort of complex there's a complex balance of bacteria in the vagina and you can alter that through all sorts of things so it's not only sort of you know Christmas bath bombs bubble bath that kind of thing but also a lot of the products that are sold to be used by women, like vaginal deodorants and FemFresh and Vagis. All of these can affect the way in which you're... And what happens is when this changes after menopause, that it allows other bacteria to overgrow.

So things like E. coli, which is one of the main bacterias that causes urine infections. On the treatment of UTIs, an NHS spokesperson said, urinary tract infections are not uncommon and many resolve within a few days with self-care measures such as painkillers and hydration. And for some people, treatment with antibiotics or vaginal oestrogen may be appropriate. For some women experiencing recurrent UTIs, adopting clinically proven measures such as drinking plenty of fluids or painkillers can also be effective in helping prevent further infections. And they're encouraging people to go to their GP if they have one.

Kate, I want to understand the experience of older women that we talked about at the beginning of our conversation, because your own mother has experience of this. Well, my mum had Alzheimer's and we had great carers looking after her, but they were away one weekend when they were on holiday and my mum dehydrated. She ended up in hospital. She'd been looking after herself at home just with a couple of people coming in. She was sort of independent and managing. And she immediately, after the UTI and being on an antibiotic drip, became completely disorientated.

For the first time, she didn't recognise me. And me and her carer had to go in turnabout to feed her because she'd forgotten how to feed herself. And she did eventually get that back. But she really didn't walk properly again. She ended up in a wheelchair. She never went back to her flat where she'd been living. She went into a home and died a year later. And I didn't at that point, because this was in 2015, I didn't know the word vaginal oestrogen. I didn't know about UTIs in that way and how it could affect your older people mentally. And it seems to just switch a button that makes everything much worse. And there's been sort of increasing studies on this now and the effect of

UTIs and dementia and confusion and that's the point at which you know people trip and fall and break a hip and things like that you know rushing to the loo and so it has all these other effects and I mean I'm not saying if she'd been on vaginal oestrogen it would have saved her from all of this but you know does that need to happen to so many older women and do they need to be miserable yeah I mean you must have older patients Olivia is it safe for all women we're hearing about Kate's mum there we're hearing about um you know women at various stages in their life who get UTIs is it safe for all women to have this well interestingly so one of the reasons I think that vaginal estrogen is so under prescribed is that I remember being told that actually it wasn't

safe. So what we were worried about, if you give systemic HRT, so HRT which goes into the whole of the body, we know that if you give someone with a womb oestrogen without progesterone, then it can lead to dangerous thickening of the womb lining. And we used to think, and I remember being taught this, that vaginal oestrogen did the same thing but we now know through good evidence that the level of oestrogen that actually goes into the bloodstream is very very low so when I try and prescribe this to older women I'll often have them say I don't want to have this I don't want HRT oh I'm long past the menopause but actually the amount of oestrogen that's going into their body is tiny it's about equivalent to taking one tablet of oral HRT a year. So actually, the

oestrogen is just going into the vulva and the vagina and the bladder. So it's really, really safe for the vast majority of women. What's your advice to women or indeed men who are worried about this, who want to seek out vaginal oestrogen but might have a reluctant GP, for example? Well, so it's really difficult and I think the one thing to say is ever in the last three years ever since the Davina McCall documentary the learning curve has been massive for GPs so at the BMS we run courses which are always full and the primary care women's health forum runs in webinars we'll have two thousands they'll have two thousand sign up to that so there is huge appetite for learning among GPs.

So if you went a year ago and your GP wasn't as pro-vaginal Eastern as you hoped, I'd say please go back, ask the receptionists. They always know who the best GP is to see. Many GPs now, they can't be experts on everything. So there'll sometimes be a GP in the surgery who is the one who keeps more up to date and who knows this. So try and find the right doctor to see. You're nodding, Kate.

Yeah. I'm also thinking that I'm so pleased we're talking about this on here. It's a good start on Women's Hour, isn't it? Yeah, yeah, yeah. But that we are afraid to use this and we're afraid to use the word vulva. We're afraid to talk about this. And also in terms of women's sex lives, you know, later on in life, God, we should be having sex. And, you know, why should we be dealing with, you know, a dry vagina, a dry vulva, when, you know, we spend all this money on our faces, on Chanel for our face, and we don't think we should be spending money on that bit

down there. We should care about that too. The whole body. Thank you very much, Kate Muir and Dr. Olivia Harman. Thank you to all of you who have been sending in your various messages. That is it from today's edition of Woman's Hour. Tomorrow, I'll be joined by Julia Hobbs from Vogue to talk about the new trouserless trend that's sweeping the catwalks and social media and the reaction she got when she tested out her statement knickers on the London Underground. I'll leave that right there. Do have a great day.

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